A contraceptive side effect is an undesirable, negative consequence of using medications aimed at preventing pregnancy. It is regarded by doctors as an inadequate response of the body to one or more substances contained in tablets, implants, patches, intrauterine devices.
Barrier contraception is not considered in this regard, since there are very few adverse reactions and all of them are predominantly local.
The most common adverse reactions when taking birth control pills
With correctly prescribed contraceptives, doctors prevent unwanted pregnancy and restore a woman’s regular menstrual cycle. However, each drug annotation indicates the most likely adverse reactions:
- Decreased libido, slight or progressive. Sometimes in the first months of taking contraceptive symptoms no symptoms arise; they can appear gradually after normalization of altered hormonal levels.
- Mood swings. The woman becomes irritable, tearful, apathy appears, giving way to mental activity. Sometimes she suffers from insomnia or, conversely, excessive sleepiness.
- Headache. Due to changes in the functioning of the endocrine glands, the activity of the brain and its blood supply change. Against this background, mild headaches are possible. If the patient has a history of migraines or idiopathic severe pain, hormones may aggravate them.
- Vaginal bleeding. Slight brown discharge in the first three months after taking contraceptives is considered normal. If the appearance of a small amount of blood on your underwear is not accompanied by pain in the lower abdomen and other unpleasant symptoms, there is no need to panic. If bleeding occurs, you should immediately seek emergency medical help.
- The appearance of blood clots. Due to an increase in the volume of estrogen produced, the composition of the blood changes. If the patient does not have chronic blood pathologies that can cause thrombosis, there will be no problems - even if a clot forms in the vessel, the body will dissolve it on its own.
- Skin problems, local or general. IUDs, implants, and patches can cause vaginal itching. At the site where patches and implants are installed, there may be redness of the skin, slight swelling, and the appearance of blisters. Oral contraceptives can either reduce the amount of acne on your face or increase it.
- Hair loss, deterioration of nails. Typically, the doctor in this case diagnoses diffuse but minor hair loss. Women notice a large number of hairs on their comb, in the bathroom after washing their hair.
- Nausea. Estrogen, especially when taking oral contraceptives, enters the gastrointestinal tract, irritating the stomach, so in the first months the girl feels painful sensations in the epigastric region. Sometimes accompanied by vomiting and stomach pain.
Breast engorgement is another minor sign of so-called addiction to contraceptives. A woman also faces other negative consequences of taking contraceptives: pigmentation, swelling on the face, excess weight (+5 kg and above), bloating, flatulence or constipation.
If these side effects do not go away within 3 months or become pronounced, you should consult a gynecologist. If measures are not taken to eliminate negative signs, serious complications are possible: thromboembolism, pulmonary artery thrombosis, and in some situations even strokes and myocardial infarction are possible.
Oral contraceptives: harm or benefit? Gynecologist answers questions
Obstetrician-gynecologist of the network of clinics “Personal Doctor” Tatyana Valerievna Imidoeva answers questions
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Tatyana Valerievna, tell our readers about modern hormonal contraceptives, what are they and how do they work?
Hormonal contraceptive pills can easily be called a unique discovery of the 20th century, which made a breakthrough in modern contraception. More than 50% of women in Europe and America prefer this method of preventing unwanted pregnancy. Unfortunately, oral contraceptives are not so popular in Russia. The main reason is myths and fears that prevent you from contacting a gynecologist, getting competent advice and a prescription for one of the most reliable contraceptives. Most of all, patients are frightened by the word “hormonal”, which paints the image of a “hairy fatty” who will no longer be able to have children or will certainly get cancer. These fears are from the past - from the 60-80s of the 20th century, when there were 2-3 drugs and the doses of hormones in them were more than 2-5 times higher than modern ones. Today, more than 20 oral contraceptives (OCs) with ideally selected microdoses of synthetic hormones are produced. Many of the modern OCs are not just means of preventing pregnancy, but also therapeutic drugs.
The principle of operation of all oral contraceptives is that under their influence, ovulation is blocked, i.e. the egg does not mature and does not leave the ovary, so the sperm have nothing to fertilize, and pregnancy does not occur.
Can taking hormonal contraceptives lead to infertility?
No, if the doctor prescribed contraceptives and prescribed the correct regimen for taking these drugs. The possibility of conception is restored 1 to 3 months after stopping taking the pills.
How long can you continue taking birth control pills without harming your body?
If there are no contraindications to taking birth control pills, then a woman can use this method of preventing unwanted pregnancy for as long as she needs it. Previously, it was believed that breaks were needed in taking oral contraceptives so that the ovaries did not “forget” their function. To date, there is no reliable statistical data that long-term use of OCs somehow negatively affects a woman’s reproductive system. On the contrary, there is evidence that breaks in taking birth control pills are a stress factor for the endocrine system, as they force the body to first spend a period adapting to taking OCs, and then again adjust to stopping the drug.
Is it necessary to change birth control pills periodically?
If the drug was correctly selected by the gynecologist and justified its effect, then there is simply no point in switching to another. It is advisable to replace the drug only if negative symptoms associated with taking OCs occur and they continue for more than three months from the start of taking the tablets. It must be remembered that contacting a gynecologist in this case is mandatory, since these symptoms may not indicate individual intolerance to a hormonal contraceptive, but the presence of some gynecological disease.
What is the likelihood of gaining excess weight while taking COCs?
A healthy woman who eats rationally and leads an active lifestyle can safely take birth control pills without fear of ruining her figure. The main thing is that before you start using hormonal contraception for the first time in your life, you must definitely contact a gynecologist for consultation and undergo all the necessary tests (detailed family and personal history, measurement of blood pressure, laboratory tests that necessarily include examination of blood clotting and hormonal levels), gynecological examination (including ultrasound examination of the pelvic organs, oncocytology) and consultation with a mammologist.
Until what age can you take birth control pills?
Age itself cannot serve as a contraindication for hormonal contraception. However, after the onset of menopause, when contraception is no longer required, using these drugs is inappropriate and sometimes even harmful to women’s health. In the period preceding menopause, it is also recommended, in consultation with a gynecologist, to replace conventional contraceptives with special hormonal agents used to compensate for the deficiency of hormones, the production of which significantly decreases with age (the so-called hormone replacement therapy (HRT)).
The correct selection of hormones in the period preceding menopause allows a woman to feel healthy, confident, and forget about hot flashes and sudden mood swings characteristic of the perimenopausal period.
Is the effect of oral contraceptives dangerous for the fetus if pregnancy occurs while taking them?
If the patient started taking oral contraceptives during pregnancy and this lasted no more than the first month of pregnancy, then they are completely safe for the unborn child. However, since in the sixth week of pregnancy the fetus begins to develop genital organs that are sensitive to the effects of hormones, hormonal medications can lead to certain disorders. In such cases, you should consult a doctor immediately.
Do oral contraceptives provide any protection against sexually transmitted diseases (STDs)?
No, birth control pills of any kind do not protect against sexually transmitted diseases and AIDS. In this sense, this method of contraception is suitable only for women who have a regular sexual partner, or for those who additionally use a condom. Only then can the actual safety of sexual intercourse be guaranteed.
How compatible are hormonal contraceptives with other medications?
The compatibility of drugs in each case may be different; it is best determined by a doctor. With this in mind, you must warn the specialist who prescribes you this or that drug that you are taking birth control pills, and accordingly, vice versa, the gynecologist should be informed about the medications you are using.
If there is a single or short-term need to take a drug that obviously reduces the contraceptive properties of the pills, during this period it is recommended to use an additional method of protection against unwanted pregnancy.
In what situations are additional contraceptive methods necessary?
The need for additional contraceptives may arise, as we have already said, in the case of taking a number of medications that reduce contraceptive properties. In addition, the use of condoms is recommended for vomiting or diarrhea that is caused by food poisoning. Hormonal substances are poorly absorbed into a weakened body, so the likelihood of pregnancy increases markedly.
In addition, it is recommended to use additional methods of contraception if you forget to take several pills. Be sure to also use a condom when having sexual intercourse with a new partner to ensure protection against sexually transmitted diseases.
In what cases is it necessary to contact a gynecologist when taking hormonal contraceptives?
In general, a woman needs to visit a gynecologist once every six months, and this applies to both those taking birth control pills and those who do not use them. However, if any unusual phenomena occur (for example, the appearance of spotting bloody discharge from the vagina), and even more so if pain occurs in the lower abdomen, it is necessary to visit a gynecologist unscheduled.
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Diagnosis before selecting contraceptives
The patient’s complaints about changes in health status become indications for a full diagnosis. In addition to general laboratory tests, the gynecologist prescribes a study on blood biochemistry and hormonal composition of the blood, determination of hemostasis (blood formation), and also proceeds to instrumental diagnostics:
- Ultrasound of the pelvic organs;
- Colposcopy;
- Survey mammography.
It is important for the doctor to differentiate the pathology from other diseases. Typically described adverse reactions are signs of inflammatory processes, benign and malignant neoplasms of the genitourinary system, diseases of the blood, gastrointestinal tract, cardiovascular system, and brain. Other highly specialized specialists are involved in the work of the gynecologist.
Intrauterine devices: advantages and disadvantages
Intrauterine devices are:
- hormonal
- non-hormonal
Hormonal IUDs have all the advantages and disadvantages of non-hormonal IUDs and, in addition, include the advantages and disadvantages of hormonal contraceptives.
The hormonal intrauterine device deserves separate consideration.
In this article, we will consider in detail the principles of operation, advantages and disadvantages of only non-hormonal IUDs.
Non-hormonal intrauterine devices: mechanisms of action
Mechanisms of action of the spiral:
- the spiral affects the composition of cervical mucus , making it thicker, which makes it difficult for sperm to move into the uterus
- affects the sperm themselves , reducing their motility
- enhances peristalsis of the fallopian tubes (i.e., accelerates the movement of the egg through the tubes), and with accelerated movement, the egg enters the uterus without having time to mature. An immature egg is not able to implant (embed itself) in the uterus.
- if fertilization does occur, it prevents the fertilized egg from attaching to the walls of the uterus
The latter property allows the use of an intrauterine device as a means of emergency contraception , which is much safer for the body than the use of special emergency contraceptive pills containing large doses of hormones.
Advantages of non-hormonal intrauterine devices
- High degree of protection
– above 95% - Can serve as emergency contraception (however, it must be installed no later than 120 hours (5 days) after unprotected intercourse)
- Long service life from 3 to 10 years
depending on the composition of the spiral - occur immediately
after removal of the IUD. - Does not affect a woman’s hormonal levels (there are no problems such as decreased libido, menstrual irregularities, amenorrhea, breast tenderness, mood swings, depression, headaches, nausea, which are inherent in hormonal drugs)
- Suitable during lactation (nursing mothers)
- Instant effectiveness
(starts working immediately after administration) - Suitable for women with certain diseases when hormonal contraceptives are contraindicated
Disadvantages of non-hormonal intrauterine devices
- Insertion and removal is possible only by a gynecologist
- It is necessary to check the presence of IUD threads
in the vagina after each menstruation in order to notice spontaneous
loss of the IUD (this happens quite rarely) - More abundant and longer periods in the first few months
after installation of the device - Possible development of endometriosis of the pelvic organs (rare)
- Increased risk of developing inflammatory diseases of the uterus and appendages
- Installation of the IUD is not recommended for nulliparous
women
Contraindications for installing a spiral
- pregnancy
- inflammatory diseases of the pelvic organs
- malignant growths in the cervix or uterine body
- bleeding of unknown etiology (the cause has not been established)
- deformation of the uterine cavity for various reasons
Treatment for side effects
If the main reason for the change in the patient’s condition lies only in taking contraceptives, the doctor takes a wait-and-see approach, for example, changes the dosage of the drug, waits another month or two, and evaluates the result. In this case, auxiliary medications help reduce unpleasant symptoms:
- Sedatives;
- Antipruritic;
- Mild laxatives;
- Painkillers and others.
If the adverse reactions are severe, the gynecologist discontinues the drug and replaces it with another. Sometimes complete withdrawal of hormonal drugs is required. Sometimes the intervention of phlebologists, cardiologists, and other specialists is required.
When are birth control pills contraindicated?
When prescribing birth control pills, the gynecologist must take into account contraindications. Since hormones regulate many processes in the body, taking oral contraceptives may strengthen or weaken some of them.
In this case, the following may occur:
- Acute chest pain.
- Dyspnea.
- High blood pressure (BP).
- Blood clots.
- Depression.
- Headache - migraine.
- Itching of the skin, genitals.
- Hearing and vision impairments.
At risk are women approaching the age of forty, smokers, and those suffering from chronic diseases of the kidneys, liver, and thyroid gland. Long-term use of COCs without replacement can also cause health problems.
Depressive conditions and hormonal contraception
Fluctuations in well-being and deterioration in mood can be caused by the action of progesterone, but, on the other hand, it is progesterone that can minimize the deterioration in well-being during premenstrual syndrome. However, remember that this is not a symptom that should be tolerated. Problems at work or setbacks in your personal life can also make you feel worse.
If you feel worse, it may be worth checking your thyroid or other hormones such as prolactin, which are responsible for mood changes.
If you have experienced depression while taking contraceptives, you should think about changing pills or contraceptive methods to others.
Why?
If you are taking birth control pills, they may (not necessarily) reduce the amount of lactobacilli present in your vagina at the correct pH and also protect it from developing infections. The pH level in the vagina should be more acidic than alkaline. Unfortunately, birth control pills can increase the alkalinity of the vagina, which leads to yeast growth and yeast infections. In such a situation, you should not only consult a doctor to treat the infection, but also, if possible, switch to another drug.
Why?
Hormonal treatment disrupts the functioning of the brain's endocrine system. Although hormonal birth control is often recommended to regulate the body's hormonal balance, it can also disrupt it.
Also remember that decreased libido can be associated with, for example, a feeling of vaginal dryness, which can also be a side effect of taking birth control pills. Talk to your doctor if the problem of decreased libido does not go away while taking birth control pills.
Most likely, the specialist will recommend replacing the contraceptive with another one that does not reduce your libido.
Skin problems and hormonal contraception
Skin problems and hormonal contraception
Treating acne with hormonal medications is quite popular and often effective. So, if you are prescribed birth control pills for dermatological reasons, you can expect severe acne when you start taking them. We can say that the skin cleanses, and the body regulates the functioning of the sebaceous glands. Of course, in such situations, the work of the gynecologist and dermatologist should be joint. If symptoms worsen, remember to take proper skin care on the outside (such as dermatologist-recommended creams or chemical peels) and on the inside, drink plenty of water.
What if you missed a pill?
Combined oral contraceptives
If you forget to take your COC tablet, there is no need to panic, just take it as soon as you remember. If one day has already passed, you can take two tablets at once or during that day with a gap. If two days in a row are missed, take two tablets on the same day and two the next day. If you have missed more than two days, it is better to consult your doctor first. You will most likely need to start a new pack of contraceptives to restart your cycle.
The moment you forget to take the drug, it is better to use an alternative method of contraception, such as a condom, as additional protection. If you forgot to take one of the last 7 tablets, it is not so critical, as they are just a placebo.
Mini-pill
With mini-pills the situation is more complicated, since it is important to take them at the same time every day, and the effect disappears faster. If you miss a dose by no more than 3 or 12 hours (depending on the drug), then take the pill as soon as you remember. Take the next one at the same time that was initially allotted for taking it, even if you end up taking 2 tablets in one day. In such a situation, when you have not exceeded the permissible time, no additional measures need to be taken. But if more than 3 or 12 hours have passed, then it should be taken into account that now you will need to use an additional contraceptive for at least two days until the effect of the drug is restored after resuming use.2
Before continuing to take contraceptives after skipping, it is recommended to make sure that conception has not occurred using a home pregnancy test. Additionally, if you haven't missed any pills but are missing your period, it's also worth taking a test. Protection against conception can be as important as protection against sexually transmitted infections. Therefore, the use of a condom may be necessary in some cases.
How to start taking them?
Regimen for taking combined oral contraceptives
There are three schemes for using this type of contraception under the guidance of a doctor.
The first method is the easiest because you start taking them on the first day of your period. Thus, protection against pregnancy begins immediately (i.e., before the first ovulation).
The second method involves starting treatment at any time during the first 7 days after the start of the menstrual cycle. This regimen is best combined with a back-up method of contraception, such as condoms and spermicides, for the first week.
And the third method involves starting to take the pill at any period of the cycle, if you are sure that conception has not occurred earlier. Protection begins after 7 days if taken correctly and continuously.
Mini-pill regimen
Choose a convenient time of day to take your first progestin-only oral contraceptive pill. Continue to take one tablet daily with a delay of no more than 3 or 12 hours (depending on the type of progestin in the composition) without breaks.
Coronary heart disease and oral hormonal contraception
If you have coronary heart disease or valve defects, combined hormonal contraceptives are not recommended.
The estrogen content of combined contraceptive pills causes a risk of embolism, as well as pulmonary hypertension or endocarditis. A detailed history will help determine whether one-way birth control is appropriate, but other methods of protection against unplanned pregnancy, such as intrauterine devices, are often recommended for this condition.
Excess weight and contraception: is it possible to gain weight while taking oral hormonal contraceptives?
Excess weight and contraception: is it possible to gain weight while taking oral hormonal contraceptives?
Sometimes women gain weight while taking hormonal birth control. This usually occurs when combined hormonal contraceptives (with added estrogen) are taken.
Estrogen is a hormone that negatively affects weight because it makes fats easier to store in the body and can also slow down the fat burning process.
Women (especially those with extra pounds) quite often believe that hormonal contraception allows them to regulate hormonal balance and thereby lose extra pounds.
If the pills are chosen correctly, excess weight should not appear.
However, some drugs can increase appetite, and hence weight gain. Unfortunately, it often turns out that the cause of weight gain is not hormones, but the lack of a balanced diet and a sedentary lifestyle. However, remember that a balanced diet and daily exercise will help you maintain a healthy figure.
When choosing contraception, the doctor should also pay attention to BMI, that is, whether the woman has a healthy body weight.
Why?
They contain very high doses of hormones that negatively affect the female body - at the moment, they are used less and less.
Modern hormonal contraception contains about 1/10 of the dose of hormones of its predecessors that existed many years ago, that is, the so-called older generation birth control pills.
Currently, birth control pills are considered safe if they are properly selected for a woman's health condition. If you notice any troubling side effects, switching to a different drug is usually all you need to get your condition back to normal.
